Submit New Application

Primary Instructor Application

Primary Instructor Applicant must:

Hold a current Oregon RN licenses
Have at least two years of RN experience
Have evidence of completion of a course on teaching adults, or one year of experience teaching adults.

Primary Instructor for MA Program: must have at least one year of long-term care experience.

Please upload a current resume and any other supporting documents.

Legal First Name

Middle

Legal Last Name

Suffix

Phone

Address

City

State

Zipcode

RN License Information

License Number

Expires

Education Program Information

Program Name

Document Upload

Teaching certificate of completion if needed

Affidavit

I am submitting this application with the approval of the program director.

By Submitting

I hereby verify that I understand and agree with the statements contained herein and the above information is true and correct.

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